Analgesic efficacy of Ultrasound-Guided Caudal Block versus Pudendal Nerve Block in BRAKA - I Repair for Paediatric Hypospadias

Objective: To compare the efficacy of ultrasound-guided caudal versus pudendal nerve block analgesia in paediatric patients undergoing hypospadias. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Rawalpindi, Pakistan from Mar to Sep 2022. Methodology: Paediatric patients with ages ranging from 4-12 years with ASA Grade I/II planned for hypospadias repair were included. Sixty-eight patients were divided into Group-C (caudal block) and Group-P (pudendal nerve block), after randomization. Group-C patients received ultrasound-guided caudal block while pudendal nerve blockade was performed under ultrasound guidance in Group- P. Demographic variables, requirement of rescue analgesics, CHEOPS scoring at 0, 1, 2,6 and 12 hours, and complications in the intraoperative period were recorded. Results: Pain scores at the 6th and 12th hour were significantly reduced in Group-P compared to Group-C. Requirement of analgesia was lesser in Group P 01(2.9%) compared to 11(32.3%) in Group C with a p-value of 0.006. Out of 34 patients in Group-C 07(20.6%), patients encountered complications compared to Group-P, which had no complications. Conclusion: Ultrasound-guided pudendal nerve block is superior to caudal block in providing adequate perioperative analgesia with fewer complications and decreased requirement of additional analgesic supplements.